
<form method="post" action="<?php echo site_url() ?>mg_saran/front" class="form-horizontal">
	<input type="hidden" name="id_menu" value="<?php echo @$get_content[0]['id_menu']?>" />
	<input type="hidden" name="id_saran" value="" />
	<table>
    	<tr>
        	<td><label class="control-label" for="nama_saran">Nama</label></td>
            <td><input type="text" name="nama_saran" value="" size="25" /></td>
        </tr>
        <tr>
        	<td><label class="control-label" for="email_saran">Email</label></td>
            <td><input type="text" name="email_saran" value="" size="30" /></td>
        </tr>
        <tr>
        	<td><label class="control-label" for="subjek_saran">Subjek</label></td>
            <td><input type="text" name="subjek_saran" value="" size="50" /></td>
        </tr>
        <tr>
        	<td><label class="control-label" for="pesan_saran">Pesan</label></td>
            <td><textarea name="pesan_saran" rows="5" cols="50" ></textarea></td>
        </tr>
        <tr>
        	<td><label class="control-label" for="captcha">&nbsp;</label></td>
            <td>
				<?php echo $image;?><br/>
				<input type="text" name="secutity_code" value="" class="span6"></input>
            </td>
        </tr>
        <tr>
        	<td><label class="control-label" for="button">&nbsp;</label></td>
            <td>
				<input type="submit" name="submit" value="Send" />
				<input type="reset" value="Reset" class="btn" />
            </td>
        </tr>
    </table>
</form>